Active NPI
David Daesoo Kim, PHD
- Professional Counselor
- Peachtree Corners, GA
National Provider Identifier
1588067771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007964
- Practice address
- 3000 Langford Rd
Building 300
Peachtree Corners, GA 30071-1521 - Phone
- (404) 512-0886
- NPI assigned
- Oct 1, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC007964 | GA | Primary |
Addresses
Primary practice location
3000 Langford Rd
Building 300
Peachtree Corners, GA 30071-1521
Mailing address
3000 Langford Rd
Building 300
Norcross, GA 30071-6675
Phone (404) 512-0886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007964 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490659200000",
"number": "1588067771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 LANGFORD RD",
"address_2": "BUILDING 300",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300716675",
"telephone_number": "404-512-0886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 LANGFORD RD",
"address_2": "BUILDING 300",
"city": "PEACHTREE CORNERS",
"state": "GA",
"postal_code": "300711521",
"telephone_number": "404-512-0886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DAVID",
"middle_name": "DAESOO",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-01",
"last_updated": "2017-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peachtree Corners, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.